catheter estimation of stenotic valves dr. dayasagar rao kims hyderabad

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  • Slide 1
  • Catheter estimation of stenotic valves Dr. DAYASAGAR RAO KIMS HYDERABAD
  • Slide 2
  • Stenotic valve orifice area- evaluation Cardiac catheterization- gold standard? Echo doppler MRI based Clinical MDCT
  • Slide 3
  • Is there role of catheter based assessment- stenotic valves in 2009? Stenotic valve orifice area- evaluation
  • Slide 4
  • ACC/AHA guidelines valvular heart disease-evaluation 2008 Discrepancy: clinical findings noninvasive data. Technically unsatisfactory non invasive data (echo-doppler) operator dependent acoustic window TEE Low flow- low gradient: aortic stenosis
  • Slide 5
  • Catheter based evaluation of stenotic orifice Is it safe? tight/ critical stenosis cerebral embolism- calcific aortic stenosis Omran et al: LANCET 2003 152 patients aortic stenosis randomized: CAG only Vs CAG + crossing of aortic valve (retrograde)
  • Slide 6
  • Stenotic orifice area (catheter based) Brain MRI: diffusion imaging 22% focal diffusion imaging abnormalities 3% clinically apparent neurodeficit only in patients- crossing of aortic valve.
  • Slide 7
  • Stenotic orifice area- catheter based Aortic stenosis: retrograde approach antegrade Mitral stenosis: LV- PCW LV- LA
  • Slide 8
  • Stenotic orifice area AORTIC STENOSIS- (LV-AO) METHODEASE OF USEDISADVANTAGE PULLBACK+++++LEAST ACCURATE FEMORAL SHEATH+++++PRESSURE AMPLIFICATION ILIAC ARTERY STENOSIS DOUBLE ARTERIAL PUNCTURE +++EXTRA VASCULAR ACCESS RISK PIG TAIL- DOUBLE LUMEN +++DAMPING PIG TAIL + PRESSURE+++EXPENSE TRANSEPTAL++RISK
  • Slide 9
  • STENOTIC ORIFICE AREA MITRAL STENOSIS LV-PCW LV-LA TRANSEPTAL PROPER PCW PRESSURE: MEAN WEDGE- MEAN PA ALIGNMENT MISMATCH- TIME DELAY 50-70 msec REALIGNMENT- PEAK OF V WAVE BISECTED BY LV PRESSURE DOWNSTROKE.
  • Slide 10
  • STENOTIC ORIFICE AREA MILDMODERATESEVERE AORTIC>1.5 sq cm1-1.5 sq cm1.5 sq cm1-1.5 sq cm